Prenatal care coverage and correlates of HIV testing in sub-Saharan Africa: Insight from demographic and health surveys of 16 countries

Abstract

Background Prenatal screening of pregnant women for HIV is central to eliminating mother-to-child-transmission (MTCT) of HIV. While some countries in sub-Saharan Africa (SSA) have scaled up their prevention of MTCT programmes, ensuring a near-universal prenatal care HIV testing, and recording a significant reduction in new infection among children, several others have poor outcomes due to inadequate testing. We conducted a multi-country analysis of demographic and health surveys (DHS) to assess the coverage of HIV testing during pregnancy and also examine the factors associated with uptake. Methods We analysed data of 64,933 women from 16 SSA countries with recent DHS datasets (2015–2018) using Stata version 16. Adjusted and unadjusted logistic regression models were used to examine correlates of prenatal care uptake of HIV testing. Statistical significance was set at p<0.05. Results Progress in scaling up of prenatal care HIV testing was uneven across SSA, with only 6.1% of pregnant women tested in Chad compared to 98.1% in Rwanda. While inequality in access to HIV testing among pregnant women is pervasive in most SSA countries and particularly in West and Central Africa sub-regions, a few countries, including Rwanda, South Africa, Zimbabwe, Malawi and Zambia have managed to eliminate wealth and rural-urban inequalities in access to prenatal care HIV testing. Conclusion Our findings highlight the between countries and sub-regional disparities in prenatal care uptake of HIV testing in SSA. Even though no country has universal coverage of prenatal care HIV testing, East and Southern African regions have made remarkable progress towards ensuring no pregnant woman is left untested. However, the West and Central Africa regions had low coverage of prenatal care testing, with the rich and well educated having better access to testing, while the poor rarely tested. Addressing the inequitable access and coverage of HIV testing among pregnant women is vital in these sub-regions.

Household factors associated with managing the HIV positive population and meeting the UNAIDS goals

“…In their study of ANC HIV testing in 18 SSA countries, they found that HIV testing is only mandatory in Rwanda and Uganda and there is evidence that "a large portion of women who received ANC are not tested for HIV in some SSA countries." 43 We also found that good testing and ARV adherence behaviors appear to flow down to others within the same household. Heads of households who are HIV positive increase the likelihood that others in the household get tested (likelihood of awareness is much higher than for those living in a household without an HIV-positive household Household factors associated with managing the HIV positive population and meeting the UNAIDS goals Journal of Global Health Reports head) and VLS24 is also much higher.…”

“…These programs generally include mandatory HIV testing coupled with other informational services for pregnant women. 43 This widespread program activity may be 'creating' the apparent gender gap for awareness and/or VLS by including testing, counseling, and even preemptive ARV treatment as part of antenatal and institutional birthing services for pregnant women. A study of the community impact of a new PMTCT program in a high prevalence area in South Africa shows that widespread PMTCT programs may explain the gender gap we see in HIV awareness and viral suppression.…”

“…This could also be because women have more touch points with the health care system during reproductive years. Awopegba et al (2020) 43 notes, however, that the implementation of opt out testing services for pregnant women differs from country to country. In their study of ANC HIV testing in 18 SSA countries, they found that HIV testing is only mandatory in Rwanda and Uganda and there is evidence that "a large portion of women who received ANC are not tested for HIV in some SSA countries."…”

Prevalence and factors associated with self-reported HIV testing among adolescent girls and young women in Rwanda: evidence from 2019/20 Rwanda Demographic and Health Survey

“…We found a strong association between pregnancy and self-reported HIV testing. This could mainly be attributable to the wide access to HIV testing among pregnant women attending antenatal clinic (ANC) visits [ 16 ]. Several studies have also found this association [ 13 , 16 , 17 ].…”

HIV self‐testing and repeat testing in pregnancy and postpartum in Northern Nigeria

“…Despite limited prenatal HIV testing in sub-Saharan Africa (6.1%-98.1%) [1], the integration of HIV testing and counselling into antenatal care has averted over two million paediatric infections in the past two decades [2]. However, undetected acute HIV infections during pregnancy and postpartum pose significant challenges to PMTCT efforts [3,4].…”